Using the Caregiverlist Star Ratings:

Overall Medicare Star Rating: This is the rating for the overall results of the government inspection reports.

Percentage of Short-stay Residents with Pressure Sores:
Residents with pressure sores need to be repositioned regularly to allow the sores to heal and to prevent new pressure sores from developing (repositioning every 2-hours). The higher the percentage of residents with pressure sores indicates the need for more C.N.A.’s to assist and for the question to be asked: Are these residents arriving to the nursing home with pressure sores or developing them after they arrive? Pressure sores can lead to infections and mobility issues. If this number is higher, does the nursing home likewise have a higher percentage of nursing aide staff to residents?

Certified Nursing Aide (C.N.A.) Hours per Resident per Day: Caregiverlist weights this ranking higher, as a C.N.A.’s largest frustration while employed at a nursing home is the inability to adequately care for all of their assigned residents. Residents with extra care needs can take up much more of a nursing aides time during a shift. This is why often private caregivers are hired to assist residents in the nursing home during the time period that Medicare is paying for the nursing home care. As assistance with personal care, exercise and meals directly impact the ability of a resident to recover from illnesses and maintain healthy aging, the C.N.A.-staff-to-resident ratio is a high indicator of the amount of care that will be provided.

Percent of Long-term Residents whose Need for Help with Daily Activities has Increased: Residents needing more assistance with their ADL’s (Activities of Daily Living), require more assistance from a nursing aide. When there are not enough nursing aides staffed, residents miss showers, miss getting dressed daily, miss physical therapy and miss participating in activities. There is an ongoing debate about feeding tube usage and medication usage in nursing homes, as both have increased dramatically in what some say is a way to compensate for a lack of staff to provide adequate care to active residents. If there are more residents needing help with ADL’s, then more C.N.A.’s would be required.

Daily Price: How much will you pay per day when the Medicare coverage ends? In the event long-term nursing home care is required, how much will it cost? If you are in a situation where you will spend-down your assets paying for nursing home care, will the nursing home accept Medicaid as payment? If you are entering a nursing home on Medicaid, how do the quality standards rank?

Health Inspections

The government inspection reports are conducted once every year, on average. There are 180 regulatory standards which are evaluated, and more than 20% of data is missing in these reports which are shared on Medicare.gov. Some of the criteria has a high probability to be inaccurate, as it is self-reported by the nursing home or is subjective information.

Caregiverlist uses the health inspection data as a starting point to assist seniors and their families to ask the right questions to properly evaluate a nursing home. Caregiverlist uses the criteria which has the highest probability to be accurate and is a high indicator of overall quality of care. By evaluating the price, number of beds, star ratings and violations, consumers can make an informed decision.

Violations

Nursing home violations are not included in the health inspection reports.

Violations are managed by each state’s department of health. Nursing homes must pay a fine when they have a violation or they may appeal the violation. Sometimes the fines are reduced upon appeal.

Violations are disciplinary actions initiated by the state’s department of health for nursing homes in violation of the Nursing Home Care Act, or for homes that have been recommended for decertification.

Thousands of violations are filed each year – ask the nursing home to share with you any violations they have been issued in the last year, as even good nursing homes will occasionally have a violation.

Check with your state’s department of health for their quarterly update of nursing home violations.